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Arsenic is present in most waters, although usually in tiny amounts. Nevertheless,

natural arsenic contamination is high enough to cause concern in parts of many
countries including : Argentina, Chile, Bangladesh, China, India, Mexico, Thailand
and the United States of America. The source is
geological and affects the ground water: the water
beneath the earth's surface that is collected from wells. Until the arsenic-related
health problems became apparent in Bangladesh, the high levels of arsenic in the
ground water had not been appreciated. The scale of the problem was realised only
when the effects of poisoning were diagnosed in the population.

There are no easy community solutions for high natural arsenic contamination in
Bangladesh because of the co-existing socio-economic and infrastructure problems.
If arsenic contamination is recognised, relatively inexpensive water treatment can
remove it, for example with candle filtration systems for use for a short period in
the home or with a sachet of chemicals. Arsenic can also be removed before water
distribution, but this requires a fairly sophisticated water treatment system.

Arsenic poisoning: an ancient—and modern—hazard

Arsenic compounds have been known since ancient times and the metallic form was
isolated over 700 years ago. Inorganic arsenic is acutely toxic. Murderers have used
its ability to slowly kill a victim from apparently natural causes: large doses—far
higher than are found in water—cause rapid deterioration and death. Slow
exposure, as in low-level water contamination causes several long-term effects. The
effects of this arsenic poisoning, known as arsenicosis, can take a number of years
(typically 5 – 20) to develop. Arsenic exposure via drinking water causes cancer in
the skin, bladder and kidney, as well as skin changes such as hyperkeratoses (hard
patches) and pigmentation changes. These and other health damaging effects are
summarised in Table 1. It has been estimated that one in ten people who drink
water containing >500 µg of arsenic per litre may ultimately die from cancers of the
lung, bladder and skin. Occupational exposure by arsenic is mainly by inhalation
and increased risks of lung cancer have been reported at cumulative exposure
levels of = 0.75mg/cubic metre. This amounts to around 15 years exposure at a
work-room concentration of 50µ/cubic metre. Tobacco smoking has been found to
interact with arsenic in increasing the lung cancer risk. Because of multiple
exposures and interaction with other toxic exposures, the relationship between
arsenic and disease is not clear cut for all the postulated effects, such as diabetes
and cerebrovascular disease.

Box 1: Long-term health effects of exposure to arsenic

• Skin lesions and skin cancer

• Internal cancers: bladder, kidney, lung

• Neurological effects such as polyneuropathy and encephalopathy

• High blood pressure and heart disease

• Lung disease

• Gastrointestinal symptoms

• Bone marrow depression

• Destruction of red blood cells

• Enlarged liver

• Disease of the blood vessels, including peripheral vascular disorders

such as blackfoot disease in Taiwan, so named because it can result
in gangrene of the feet

• Diabetes

Who is at risk?

The very young are particularly vulnerable to the toxic effects, although all ages can
be affected. Poverty and poor nutrition increase the chance of toxic effects. A
vicious cycle can result, where people made sick by arsenic lose their jobs and
become a burden to their family. Many of the long-term harmful effects are
irreversible. In the early stages, drinking arsenic-free water and eating nutritious,
vitamin-rich food can reverse some effects. Surface waters, such as lakes and
rivers, are less likely to contain toxic levels of arsenic. While safer in terms of
arsenic levels, such waters may carry a much greater risk of infection. Waterborne
infection kills far more people than arsenic, so the use of alternative sources has to
be carefully considered, taking the ability to limit or control infection hazards into

Unlike fluoride, arsenic has no apparent beneficial health effects for man and other
animals. Unfortunately, we cannot completely remove all traces of this element
from water. The acceptable upper limit for arsenic in water has been progressively
lowered: before 1993, the WHO guideline value was 0.05 mg/ litre. Now it is 0.01
mg/litre [mg/l or milligrams per litre].

If arsenic can be reduced in water supplies, why is it a world wide water

The first problem is knowing that it is there: this means testing water supplies.
Apart from the cost of testing, someone has to be responsible for making sure the
testing is done: this can be a problem in small supplies such as a village well.
Education, training and monitoring are expensive and this is one of the greatest
problems in controlling arsenic contamination and its effects. The cost can be kept
down by restricting the testing to water used for drinking purposes: arsenic
contaminated water may be used safely for bathing and laundry purposes. Quality
control—making sure the analysis is correct—is also important.

While chemical or filtration treatment is effective, there can be problems in the use
of chemicals to remove arsenic. For example, alum (aluminium sulphate) requires
prolonged contact with the water to remove sufficient arsenic, which may be
difficult in supplies without a water treatment works. Letting the water settle helps
in iron rich waters, but only a proportion of the arsenic sinks with the iron, so this is
not satisfactory for high levels of contamination. The amount removed varies
according to several factors such as the concentrations of arsenic and iron and the
standing time.

Arsenic is now little used in industrial and agricultural processes. In the past it was
used as a pesticide, especially in orchards and as a component of wood
preservative: small amounts could be leached from treated wood, such as electricity
pylons. In the early stages of the investigation of the problem in Bangladesh, this
was suggested as a possible cause. While arsenic can be found in minute amounts
in air, food and water, the largest exposure is via the natural levels in water.

Long term solutions for arsenic in water

The Bangladesh arsenic emergency has shown the problem of using shallow wells in
areas with high natural arsenic levels. The long term potential answers for
Bangladesh include the following:

• Deeper wells — 200 metres or more down — are less likely to be

contaminated. They have to be installed carefully to prevent water from more
superficial sources seeping in. In Bangladesh, the long-term sustainability of
these sources may be an issue.

• Rain water harvesting: particularly suitable in areas of high rainfall such as

Bangladesh, although the collection systems for the rainwater have to ensure
that there is no risk of infection, or increasing other problems, such as
mosquitoes breeding on the surface of tanks.

• Education programmes: people get used to a particular type of water

supply and cannot be expected to change habits overnight. Any long term
solution must include wide scale education and training about the harmful
effects of arsenic and how to avoid them.
• Arsenic removal systems may be suitable for long term use, although this
needs a centralised system to ensure good maintenance and regular disposal
of the arsenic sludge. Domestic treatment systems can be used as an
alternative to centralised arsenic removal, or to supplement such systems.

Precautions for controlling arsenic in water

In addition to the possible solutions, the Bangladesh arsenic problem has

highlighted the value of testing and monitoring waters that may be at risk. This
includes monitoring of water from vulnerable aquifers and conducting
reconnaissance surveys to identify whether arsenic levels are a problem in
previously unsuspected waters. Clinical monitoring for early signs of arsenic
poisoning is also important: this is one of the ways in which the Bangladesh problem
was identified. Clinical monitoring involves regular checks by doctors and nurses
and surveillance systems to detect early signs of arsenicosis in the population.
Common signs include hard patches on the palms and soles of feet and hyper-
pigmentation (darker patches on the skin) and health workers can be quickly
trained how to recognise them.