SPECIAL ARTICLE
An Evidence-based Inquiry into the Endosulfan
Tragedy in Kasaragod, Kerala
K M Sreekumar, K D Prathapan
A review of the literature on the toxicology of endosulfan
and assessment of the various pesticide-regulating
agencies worldwide, as well as a statistical analysis
of the medical camp data and primary data of the
2015 Kerala Disability Census, is carried out to
elucidate possible evidence for higher prevalence of
disabilities and disorders in the endosulfan-sprayed
areas in Kasaragod, Kerala. The enquiry does not
indicate a higher prevalence of the health problems
in the endosulfan-sprayed areas in Kasaragod,
compared to the unsprayed areas in the place and
elsewhere in Kerala.
The authors thank V Raman Kutty and the anonymous reviewer for
comments that improved the final manuscript. They also thank
A Vijayaraghavakumar for the statistical analysis of the data.
K M Sreekumar (sreekumar.km@kau.in) is with the Kerala Agricultural
University, Kasaragod. K D Prathapan (prathapankd@gmail.com) is with
the Kerala Agricultural University, Thiruvananthapuram.
Economic & Political Weekly EPW october 9, 2021 vol lVi no 41
I
t is known that aerial spraying of endosulfan in the cashew
estates of Kasaragod, Kerala, over a period of 20 years,
caused severe health hazards and deaths. Many consider
the endosulfan tragedy as equivalent to the Bhopal gas tragedy.
The Calicut Medical College and the National Institute of
Occupational Health (NIOH), Ahmedabad have conducted
epidemiological studies in the affected area and the results are
available in the public domain. The Kerala State Department
of Health and Family Welfare classified 6,728 persons with
different types of diseases as “endosulfan generated,” and 779
deaths were recorded as due to endosulfan poisoning (GoK
2019). The 6,728 persons who are included in the endosulfan
victims’ list are being provided with a monthly pension, lump
sum financial assistance to the tune of `2 lakh to `5 lakh, free
ration, financial aid for all medical treatments, moratorium on
loan repayments, free houses, etc. Hitherto, `281 crore has
been spent for the welfare and rehabilitation of the victims of
the endosulfan tragedy by the Government of Kerala (GoK),
in addition to `220 crore by the National Bank for Agriculture
Rural and Development (NABARD). The rehabilitation package
ordered by the Supreme Court will be implemented at an ad-
ditional cost of `220 crore. However, a large section of the me-
dia, public and the intellectuals believe that the pesticide might
afflict future generations and the compensation offered is in-
sufficient, and hence, they support strikes for higher compen-
sation by the victims’ groups.
One of the reasons that this pesticide molecule was declared
as a persistent organic pollutant (POP) by the Persistent
Organic Pollutants Review Committee (POPRC) in Stockholm
in April 2011 was the campaign by the various stakeholders
against the backdrop of the health issues seen in Kasaragod.
Many non-governmental organisations, such as the Pesticide
Action Network, the Centre for Science and Environment (CSE) in
New Delhi, and Thanal (2009) in Thiruvananthapuram played
a crucial role in the anti-endosulfan campaign globally. The
Pesticide Action Network Asia Pacific (PANAP 2008) reported
the health and environmental effects in Kasaragod, stating:
The village of Kasaragod in Kerala, India, experienced sustained
exposure to endosulfan as a result of 20 years of aerial spraying of a
nearby cashew nut plantation. Endosulfan was the only pesticide used.
Twelve streams used by the villagers originated in the plantation and
were subsequently found to have contaminated sediment and water
throughout the year (outside the spray season), as a result of endo-
sulfan’s persistence in soil and the soil being carried to the streams
by storm runoff. Residues were still detected in the water and pond
sediments 1.5 years after spraying ceased. One sample contained
45
SPECIAL ARTICLE
endosulfan at 391 times the maximum permissible level. The villagers panchayats lying close to the cashew estates of the
were also directly exposed to spray drift. Numerous congenital, re- Plantation Corporation of Kerala (PCK) and away from it are
productive, long term neurological and other symptoms were expe-
given in Table 1.
rienced. One hundred and ninety seven cases were documented from
just 123 households. Chronic morbidity was 70% higher than the norm. Ward-wise disabled population was taken from the disability
census and the total population was taken from the 2011 Census
Quijano (2002), after a field visit, reported that there is an data. The proportion of the disabled with respect to the total
unusually large number of illnesses occurring among the people population was found out. The test statistic is assumed to
in the villages, mainly due to endosulfan. The Democratic have a normal distribution. The prevalence (out of 10,000 in-
Youth Federation of India moved the Supreme Court seeking dividuals) and “Z” values were worked out, and are presented
assistance for the victims of endosulfan. in Table 4 (p 51).
We are of the firm opinion that the insecticide endosulfan
should be banned. Better molecules, which are less environ- Science of Pesticide Use
mentally harmful, but more specific and effective in pest Pesticides are poisons. The effect of a poison is directly
management, are available at present. We always advocate proportional to its dose. Below certain limits, pesticides do not
integrated pest management (IPM), which is the harmonious produce any toxic effect—termed as no-observed-adverse-
use of different management measures in which pesticides effect leve (NOAEL)—and the dose required to kill 50% of an
are the last option. In this paper, we review the internationally organism is termed as LD50. There are many such indices
accepted argument that aerial spraying of endosulfan has derived through standard toxicological experiments. The
resulted in widespread health problems. toxic effect of a pesticide also depends on the organism, espe-
cially its body weight. When the organism is larger, the poi-
Methodology son gets diluted within the body and thus reduces the impact.
Twenty-six comprehensive medical camps were conducted in 11 Hence, the LD50 value is expressed as mg/kg of body weight.
gram panchayats—Badiyadka, Bellur, Enmakaje, Kumbadaje, The body weight of an insect is just around 60 mg, while that
Karadka, Muliyar, Ajanur, Kallar, Panathady, Pullur–Periye of a human being is around 60 kg, the difference being one
and Kayyur–Cheemeni—affected by the aerial spraying dur- lakh times, which gives a wide safety margin. Thus, while the
ing 2010–11, to identify the victims of the endosulfan poison- field dose of a pesticide is lethal to the insect, it is almost
ing. There was very intense campaigning in the run up to these non-toxic to humans. Moreover, precautions are specified to
camps and the Department of Health, GoK arranged a large reduce the exposure.
number of vehicles to carry the disabled patients to the camps. All organisms possess several detoxifying enzymes in their
In the 2010 state budget, well before the commencement of the body. Among these, monooxygenases are generalist enzymes
camps, a substantial allocation was earmarked for the finan- that will detoxify any poison. Thus, insect pests exposed con-
cial assistance and further treatment of the victims to be iden- tinuously over generations to a pesticide become selected for
tified. The campaigning and the offer of financial assistance resistance against it. The human liver produces many such
motivated a large number of people to attend the camps. enzymes, which are inevitable for survival.
Hence, in general, participation in these camps could be con-
Table 1: Wards of the Gram Panchayats Lying Close to and Away
sidered equivalent to a house-to-house survey. The details of the from PCK Estates
patients that attended the medical camps conducted in the af- Sl Name of Gram Wards Which Are Total Wards Which Are Away Total
No Panchayat Lying Near the PCK No from the PCK Estates No
fected panchayats were collected from the Department of Cashew Estates
Health and Family Welfare, GoK. 1 Ajanur 1, 2, 3 3 4, 5, 6, 7, 8, 9, 10, 11, 12, 15
The disability census was a massive census exercise conducted 13, 14, 15, 16, 17, 18
under the leadership of the Department of Social Justice, GoK 2 Badiyadka 6, 7 2 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 17
13, 14, 15, 16, 17, 18, 19
in 2015. Twenty-two different types of mental and physical dis-
3 Enmakaje 1, 2, 3, 5, 6, 7, 8, 13 4, 11, 12, 13, 14 5
abilities were identified as well as information on the reasons 9, 10, 15, 16, 17
for the disability, sex ratio, and socio-economic status of the 4 Kallar 9, 10, 11, 13, 14 5 1, 2, 3, 4, 5, 6, 7, 8, 12 9
disabled were collected, classified and tabulated. The report is 5 Kayyur– 9, 11, 12, 13, 14 5 1, 2, 3, 4, 5, 6, 7, 11
available on the website of the Kerala Social Security Mission Cheemeni 8, 10, 15, 16
(KSSM) of the Social Justice Department (GoK 2015). The ward- 6 Kodom– 10, 11 2 1, 2, 3, 4, 5, 6, 7, 8, 9, 12, 17
Belur 13, 14, 15, 16, 17, 18, 19
level data pertaining to the Kerala Disability Census 2015 was
7 Kumbadaje 5, 6, 7, 8 4 1, 2, 3, 4, 9, 10, 11, 12, 13 9
collected from the Directorate of the Social Security Mission,
8 Muliyar 1, 3, 4, 6, 7, 12, 9 2, 5, 8, 9, 10, 11, 6
Thiruvananthapuram. Seventeen types of disabilities—autism, 13, 14, 15
blindness, cerebral palsy, chronic neurological disorders, 9 Panathady 5, 6 2 1, 2, 3, 4, 7, 8, 9, 10, 13
deaf blindness, epilepsy, hearing impairment, intellectual dis- 11, 12, 13, 14, 15
ability, kyphosis, learning disability, locomotor disability, low 10 Pullur– 14, 15, 16 3 1, 2, 3, 4, 5, 6, 7, 8, 13
Periye 9, 10, 11, 12, 13
vision, muscular dystrophy, mental illness, multiple disabili-
Total 86,091 48 1,95,065 115
ties, short stature/dwarfism, speech and language disability— population
were selected for this study. The ward-wise details of the gram Source: Kasaragod District Census Handbook (GoI 2011).

46 october 9, 2021 vol lVi no 41 EPW Economic & Political Weekly


Besides the basic toxicological investigations, various other
tests are conducted to assess the carcinogenicity, teratogenicity,
genotoxicity, biomagnification and accumulation potential of
a molecule before it is used as a candidate pesticide. These
tests are again validated by the accredited laboratories of the
Food and Agriculture Organization (FAO) and the World Health
Organization (WHO), as well as various national agencies. Fol-
lowing the widespread use for five or ten years, reviews will be
conducted by the national regulatory agencies to assess any
further adverse effect over long-term use. Nowhere in the
world has pesticide use at pest-management concentrations
caused permanent adverse impact on the health of people.
Endosulfan: Usage and Concerns
Endosulfan is an off-patent insecticide-cum-acaricide that was
developed in the 1950s. It was extensively used in Europe, the
United States (US), China, Australia and other major countries.
The global consumption was 12,800 tonnes per year in the
1990s. It was recommended for pest control in more than 100
crops, including food crops, for managing a wide spectrum of
insect and mite pests. Its major use in Australia was in cotton
(70%) and it was applied aerially in significant quantities
(APVMA 2010). India was the largest producer and consumer
by 2004 (Li and Mcdonald 2005). In the US, the consumption
was 8,150 metric tonnes (MT) in 1992, while Europe consumed
5,000 MT per year in the 1990s. Worldwide production was
20,000 MT per year in the 2000s, of which India’s contribution
was 16,500 MT. Consumption of endosulfan in India was 5,000
MT (Janssen 2011). The consumption in Kerala was less than
1% of its use in the country. The major endosulfan-consum-
ing states were Maharashtra (15%), Andhra Pradesh (14.3%),
Madhya Pradesh (10.1%), West Bengal (9.3%) and Rajasthan
(7.5%) (Ramachandran 2011). Everts et al (1983) reported that
in many African countries, endosulfan was sprayed continu-
ously for 20−25 years to manage tsetse flies (Glossina spp),
which are the vectors of sleeping sickness (Grant 2001). How-
ever, subsequent studies did not report any human health im-
pact. In Australia, it was sprayed four to five times a year for
about 20 years at doses as high as 2.8 kg/ha extensively
against pests of cotton, with later studies not reporting any hu-
man health impact (Fragar and Temperly 2008). Various acci-
dents and environmental incidents, involving endosulfan
worldwide, were listed out by Janssen (2011). However, in no
case were there human health issues akin to the tragedy in
Kasaragod, due to its normal pest-management use.
In India, the NIOH, Ahmedabad conducted a preliminary
exploration into the link between endosulfan and its possible
adverse consequences on health. In its epidemiological
study, the health issues in the Enmakaje gram panchayat,
which is adjacent to one of the PCK estates, were compared
with Meenja gram panchayat, which is away from the PCK
estates (NIOH 2002). According to the NIOH (2002), there is
significantly higher prevalence of neurobehavioural disorders,
congenital malformations in female subjects and abnormalities
related to the male reproductive system in the study popula-
tion, compared to the reference population. It was concluded
Economic & Political Weekly EPW october 9, 2021 vol lVi no 41
SPECIAL ARTICLE
that the most probable aetiological factor for the higher
prevalence of such health issues in the study group could be the
relatively high and continued exposure to endosulfan. The
NIOH had promised a detailed epidemiological study, which was
never conducted. Other studies also pointed to the same con-
clusion, but were challenged. Sreekumar and Prathapan (2013)
provided a detailed critique of the Calicut Medical College
study (Prabhakumari et al 2011) and a study by Embrandiri
et al (2012), which included methodological issues, inconsist-
encies in the results and conclusions and opportunistic use
of scientific claims.
Southern Spain is an area of green house agriculture where
endosulfan was used intensively. Most of the studies on the
body burden of endosulfan relate to this area. Carreño et al
(2007) found endosulfan or its metabolites in 100% of the
blood samples from 220 young males; Lopez-Espinosa et al
(2008) found endosulfan or its metabolites in 16% of the young
boys aged 0−15 years; Botella et al (2004) found them in 78%
of adipose and 96% of serum samples from 200 postmenopausal
women; Torres et al (2006) found them in maternal adipose
tissue and serum, and in umbilical cord serum of 61% of 72
women giving birth by caesarean section. Other studies from
Spain revealed presence of endosulfan in female adipose tis-
sue (Hernandez et al 2002; Cerrillo et al 2005, 2006; Ibarluzea
et al 2004); in breast milk (Campoy et al 2001); in placenta and
umbilical cord blood (Cerrillo et al 2005); and in blood serum
(Martinez Vidal et al 2002). However, in none of the above
cases was conclusive evidence relating endosulfan content in
the body to health issues reported, except some suggestive
links to cryptorchidism and hypospadias.
Saiyed et al (2003) reported chronic effects on male repro-
ductive development, including delayed sexual development
and reduced synthesis of testosterone in the endosulfan-
sprayed areas of Kasaragod. The endosulfan content reported
in the blood of the children of the study group was 7.47 parts
per billion (ppb), whereas that of the reference group was 1.37
ppb. It may be pointed out that the endosulfan content of the
pond water was >0.03 ppb, drinking water was only 0.00738
ppb, and that of the soil was 0.988 ppb. These values are well
below the minimum detection limit of 1, 1, and 3 ppb for alpha
and beta analogues and endosulfan sulphate, respectively,
described by the author in his methodology (NIOH 2002: 84). It
may also be noted that the endosulfan content in the blood of
the subjects was 250 times higher than that in the drinking
water. No study has ever proven bioaccumulation of endosul-
fan in mammalian blood under tropical conditions. On the
contrary, numerous studies have shown that endosulfan in the
blood will be converted into endosulfan diol and excreted out
(ATSDR 2015; APVMA 2010).
However, Saiyed (2004) responded to the criticisms and jus-
tified the findings. The highest residue value in soil from a PCK
estate was 3.815 ppb, reported in a 2001 study by the Kerala
Agricultural University (KAU) (range: 50 ppb−3.815 ppb) that
was used to justify these residue levels and not the average
value, which is irrational. The health investigation level (risk)
established for endosulfan and its residues in soil is fixed as
47
SPECIAL ARTICLE
160 parts per million (ppm), and that of the Kasaragod soil
was just 3.8 ppm (Marshal and Rutherford 2003). According to
the KAU study, samples taken on 19 February 2000, that is 50
days after the last aerial spraying, showed the degradation of
the pesticide from 500 ppm to 0.5 ppm−0.8 ppm on cashew
leaves, 0.05 ppm−3.8 ppm in soil, 0.3 ppm in pond sediment
and no residue in water (KAU 2001 qtd in GoK 2001: 29). This
clearly shows the first-order kinetics of endosulfan degrada-
tion in a tropical environment, which was not considered by
Saiyed. He justified high residues in the blood of teenaged
boys because, “endosulfan attached to soil particles can enter
the body through the dermal route, more so in a hot and
humid climate (excessive sweating), and through ingestion,
particularly in children, who commonly have hand-to-mouth
behaviour,” which is unscientific and unsubstantiated, as teens
normally are not prone to such behaviour (Saiyed 2004).
Slight delay in sexual maturity in the endosulfan-exposed
group of boys in their teenage years is the salient finding of the
study. Long-term follow up of these children was essential to
corroborate the finding and their implications, which was not
done by the research team, though it was promised. Saiyed’s
study was part of the NIOH (2002) study, of which he was the
principal investigator. In the NIOH (2002: 6) report, it is clearly
stated that the findings of very high residues of endosulfan in
the blood of people by the CSE (2001) is unscientific. However,
Saiyed (2004) quoted the very same data to justify his results.
Additionally, in the sexual maturity rate (SMR) scoring of
pubic hair, penis and testis, neither was the scoring criteria
provided nor were the observers blinded, and thus, the small
differences observed indicate the obvious potential for observer
bias. Endosulfan residues in the range of 0 ppb−1,295 ppb
(mean 42.6 ppb) were reported in the blood of students of
Coimbra, Portugal; however, without any apparent health
effect (Lino and da Silveira 2006).
Assessment by Regulatory Agencies
Like any other pesticide, endosulfan had also undergone strin-
gent regulatory requirements of the respective countries
before its registration for use, and was also subjected to sub-
sequent reviews in detail. The Agency for Toxic Substances
and Disease Registry (ATSDR) is a federal public health agency
of the US Department of Health and Human Services. The
ATSDR generates and compiles extensive information on the
harmful health effects related to exposure to natural and
man-made hazardous substances, and provides advisories.
The ATSDR (2015) states the health effects of endosulfan
depending on the extent and duration of exposure. It further
states, “environmental monitoring data suggest that any
endosulfan level that the public might encounter through con-
tact or through water, soil, or food is generally much lower
than animal-study levels” (ATSDR 2015). No study indicates
cancer in humans after oral exposure to endosulfan. Further,
“the carcinogenic effects of endosulfan were investigated in a
number of chronic animal bioassays with rats and mice; the
available data provide no evidence that endosulfan is carcino-
genic” (ATSDR 2015). The US Department of Health and Human
48
Services, the US Environmental Protection Agency (EPA), and
the International Agency for Research on Cancer (IARC) have
not classified endosulfan as carcinogenic. Also, “people who
ingested endosulfan either intentionally or in contaminated
food, or those who were exposed during spraying operations
suffered tremors and seizures and some died. Similar effects
were observed in animals exposed briefly to high levels of endo-
sulfan” (ATSDR 2015). There are no studies on people exposed
to low levels of endosulfan over long periods of time (that is,
years). The ATSDR (2015) report also states:
Animal studies have shown that intake of endosulfan through food,
over long periods, affects mainly the kidneys … Endosulfan and its
breakdown products (metabolites) could be detected in blood, urine,
fat tissue, and breast milk. However, detection of endosulfan in body
tissues does not necessarily mean that one will suffer adverse health
effects. Since endosulfan and its metabolites leave the body fairly rap-
idly (within days), the tests need to be conducted within a few days
after exposure.
Further,
We do not know whether endosulfan can induce birth defects in chil-
dren. Studies have examined possible associations between maternal
exposure to endosulfan and autism, thyroid function, and develop-
ment of the nervous system in newborn children. Information is also
available on potential associations between direct exposure of chil-
dren to endosulfan and blood cancer and sexual maturation in males.
In all these cases, the results were only suggestive—not conclusive—
due to innate limitations of the studies. (ATSDR 2015)
The US’s EPA (2010) concluded that there are “risks above the
agency’s level of concern to aquatic and terrestrial wildlife, as
well as to birds and mammals that consume aquatic prey” in
which endosulfan has bioaccumulated due to endosulfan’s
POP character. Also, occupational assessment indicates short
and intermediate term risks for workers during mixing and
loading and application for the majority of uses, which is of
concern, but does not present a risk to human health from die-
tary exposure (EPA 2010).
The FAO/WHO Joint Meeting on Pesticide Residues (JMPR)
concluded that the long-term intake of residues of endosulfan
from uses that have been considered by the JMPR is unlikely to
present a public health concern. Further, the short-term intake
of residues of endosulfan resulting from the uses on those
which have been considered by the JMPR, except the uses on
broccoli, celery, cherries and tomatoes, are unlikely to pose a
public health concern (FAO 2006).
The Australian Pesticides and Veterinary Medicine Authority
(APVMA 2010) had reviewed and evaluated the toxicity of
endosulfan. Chronic toxicity studies in mice, rats and dogs
indicate that oral doses of endosulfan above 1 mg/kg/day
(1 ppm) for 36 to 104 weeks lead to hepatotoxicity and renal
toxicity as the most common findings. Endosulfan has only
limited bioaccumulation, and is rapidly excreted in a wide
range of species studied. The cause-effect relationship with
autism spectrum disorder is not proven. Endosulfan has limited
endocrine disrupting potential in mammals and it does not
appear to bioaccumulate. Rats given endosulfan at a dose of
3 mg/kg bodyweight/day by intraperitoneal injection showed
changed dopamine levels, which is irrelevant to agricultural
exposure situations. Endosulfan binding to oestrogen receptor
october 9, 2021 vol lVi no 41 EPW Economic & Political Weekly

is insignificant and hence there exists only reduced potential
for endocrine disruption. Dietary administration of endosulfan
to pregnant rats at the highest tolerated dose of 29.8 mg/kg
body weight (400 ppm) from gestation day 6 to lactation day
21 (a dose which produced marked maternal toxicity) did not
produce evidence of developmental neurotoxicity, survival
and sexual maturation in the offspring. Human epidermis is at
least 30 fold less permeable to endosulfan than rat epidermis,
hence the potential risk of exposure to workers who handle the
chemical is less (APVMA 2010).
Extensive health and safety assessment of all types of workers
in connection with cotton cultivation and aerial spraying shows
that the total amount of endosulfan possible to be received in a
human directly exposed to a recommended field application of
720 g/ha would be no more than 1 mg per person with an aver-
age body weight of 70 kg, leading to 50 ppb body wet weight
when dispersed internally. Moreover, endosulfan is degraded
and excreted from the body, with a degradation half time of
several days only, and the levels would rapidly decline after any
such exposure (authors’ communication with Ivan R Kennedy,
University of Sydney). The APVMA (2010) concluded that the
continued use of endosulfan 35% emulsifiable concentrate
would not pose an undue hazard to safety of workers. The APVMA
also considered the conclusions of Environmental Risk Man-
agement Authority, New Zealand, Pest Management Regula-
tory Agency, Canada, European Chemicals Agency, European
Union, the Joint FAO/WHO meeting on Pesticides Residues
(JMPR), Rotterdam and Stockholm conventions and USEPA and
finally concluded that use of endosulfan for pest management
does not pose a public health risk. However, the APVMA (2010)
finally decided to stop its use in pest management because
even at recommended concentrations, it poses risk to aquatic
organisms, especially fishes, through surface run-off and drift,
and supported nomination of endosulfan to the Stockholm
Convention on Persistent Organic Pollutants.
Historical Review of the Endosulfan Tragedy
The PCK, which is a quasi-government body, owns 4,696 ha of
cashew estates in Kasaragod district, spread over five divisions
and one estate in Mannarkkad in Palghat district with an area
of 340 ha. There are villages around these estates. The tea
mosquito bug (Heloptelis antonii) is the most serious pest of
cashew, causing yield losses up to 40%–50%. In association with
the fungi Colletotrichum gloeosporioides and Botryodiplodia
theobromae, it causes blight and dieback, resulting in yield
losses up to 90%–100%. For the management of this pest during
the early 1970s, ground spraying of endosulfan was practised.
This chemical was recommended by the KAU as well as the
National Research Centre for Cashew (NRCC) Puthur. Endosul-
fan was sprayed by the State Department of Agriculture, di-
rectly under the multistate cashew project, throughout north
Kerala—where cashew is a major crop—for over a decade
from 1979 to 1989. However, ground spraying in cashew is less
effective and cumbersome. Hence, an experiment on aerial
spraying of endosulfan was conducted in 1977 in the Adoor di-
vision of the PCK. The results showed that the cost-benefit ratio
Economic & Political Weekly EPW october 9, 2021 vol lVi no 41
SPECIAL ARTICLE
of aerial spraying was 1:5.8 (George et al 1984). Since 1981,
endosulfan 35% emulsifiable concentrate was sprayed three
times annually till 1983; and 1984 onwards, two times in
December and January at 500 ppm concentration as per the
Package of Practices Recommendations of the KAU. There was
peoples’ resistance against aerial spraying in Cheemeni and
Periye in 1984 itself, as there was no mike announcement to
inform the villagers in advance about the time and date of
spraying; nor were the villagers provided with polythene
sheets or thatched coconut fronds to cover the wells.
The pesticide load was 1.34 litre/ha/year (460 gm active
ingredient/ha/year). In a paddy field, if two crops of rice and
one crop of vegetables are cultivated, the average pesticide
load will be 4.5 litre/ha/year, most of which fall directly into
the water in the field. In inundated areas like Kuttanad in
Kerala, the quantity of pesticides used since the 1970s must
have been far higher than in the cashew estates of Kasaragod.
The pesticide load in tea estates was 17.28 litre/ha/year. In tea
cultivation, endosulfan, which is an insecticide-cum-acaricide,
was in regular use for at least three to four times a year.
The highest pesticide consumption in Kerala of 85 litre/ha/
year is in cardamom (derived from Usha 2007). It may also be
argued that it is not the dose per se, but the aerial mode of
spraying that resulted in the tragedy. We examine the crux of
this argument:
The size of the spray droplet is 336 µm−400 µm in the case of
high volume sprayers. As the droplet size increases, the chances
of the spray fluid falling into soil and penetrating deeper is
high. In aerial spraying, droplets of 100 µm−225 µm size,
which resembles mist, are formed and slowly pass through the
crop canopy and reach the soil surface. In cashew, seasonal
defoliation occurs in October−November after the cessation of
the monsoon rains, resulting in a mat of dry leaves over the
ground. No tillage is carried out in cashew plantations. Thus,
the soil will be covered with grasses or dry leaves and the
pesticide droplet settles on this layer instead of falling on the
soil surface. In the tropical environment, endosulfan falling
on foliage and dry leaves will degrade completely within 7–15
days. Deivendran et al (2006) reported that the residues
of endosulfan dissipated and reached below the maximum
residue limit (MRL) of 2 ppm one day after spraying on cauli-
flower curds and the half-life period was 1.81 days. If, at all, a
part of the pesticide reaches the soil, it would be degraded
beyond detection within the four ensuing summer months
from February to May, since first-order reaction kinetic was
confirmed to describe the dissipation (Ntow et al 2007;
Rosendhal et al 2009).
The KAU study team that had examined the residues of
endosulfan in soil and plant samples on 19 February 2001, that
is, 50 days after the last aerial spray, could not detect any resi-
due, except from one soil sample (GoK 2001). If, at all, the
chemical does reach the soil, the chances that the residue
reaching the streams through soil erosion is very rare, since
soil erosion is very low in cashew plantations. Winter rains
are rare. Summer showers are normally insufficient to cause
soil erosion. Once the south-west monsoon starts, the rain—
49
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3,350 mm annual rainfall—is so strong that the pesticide-laden case in the history of medicine in which all the diseases
soil will be washed off through the streams. However, there is prevalent in an area were adjudged as induced by a single toxic
no chance of the residue reaching the human system through molecule, which was sprayed in that area 10 years ago, at a
water. Alpha- and beta-endosulfan and endosulfan sulfate concentration far below the NOAEL. In Table 2, the prevalence
adhere to the soil particles and stay bound to the soil, and will of the disease affecting the central nervous system (CNS) in
come to the aqueous phase in very low quantities (ATSDR 2015). the sprayed areas, as per the medical camps, is compiled and
Thus, in majority of the studies, endosulfan was detected compared with the national average prevalence. The total
in the mud at the base of the waterbodies and not in the water. population of the 11 endosulfan-sprayed panchayats, as per
Moreover, its solubility in water is only 0.32 mg/litre. 2011 Census, was 2,97,726.
The next possibility for poisoning is through the Table 2: Prevalence of Central Nervous System Insults in Endosulfan-sprayed Panchayats
consumption of drinking water in the wells, con- in Comparison with the National Average
taminated directly by aerial spraying. The quantity of Diseases/ Total Number Prevalence National Average Remarks Reference
Disability of Cases in (per 1,000) Prevalence
diluted spray solution reaching the well water will be Endosulfan-
too low to cause any poisoning, even if the thatched sprayed Areas

coconut leaves supplied by the PCK for covering the Mentally 748 2.5 4 out of 1,000 Low Paul and Bagga
challenged individuals (2011); GoI (2017)
wells were inadequate or ineffective. Moreover, Cerebral palsy 300 1.06 2 out of 1,000 Low Anish et al (2013)
during the entire 20-year period when aerial spraying individuals
was in vogue, there was not even a single case of acute Epilepsy 108 0.38 3–5 out of Low Kasper et al (2008)
poisoning reported due to drinking of contaminated 1,000 individuals

water from any of the villages around the PCK Congenital 18 (1–14 1 0.2–0.5 out of Equal Venkataramana
hydrocephalus age group) 1,000 deliveries (2011)
estates. Once endosulfan falls in water, it will be Congenital 1 1 1 out of 4,000 Equal Unnikrishnan et al
converted into less toxic endosulfan diol that will hypothyroidism deliveries (2011)
be excreted from the body (ATSDR 2015). Source: Authors’ compilation.

The occupational safety administration of US has fixed the It is estimated that the number of live births in the popula-
limit of endosulfan content of the ambient air as 0.1 mg per m 3 tion is 4,000. Mental challenges, cerebral palsy, hydrocephalus
for eight hours of exposure per day. When aerial spraying is and congenital hypothyroidism are projected as endosulfan-
undertaken twice or thrice a year, the concentration of the induced by the media. Photographs of such patients were
chemical in the air will be far below this limit. In many African shown in the official publications of the GoK (2011: 63, 64);
countries, aerial spraying of endosulfan was carried out since however, data presented in Table 2 indicates that the incidence
the 1970’s under the supervision of the WHO, to manage tsetse of these CNS insults are below or equal to the national average
flies, which as stated above, are vectors of the sleeping sickness in the endosulfan-sprayed gram panchayats.
disease. The WHO had studied the health issues in the sprayed It is argued that endosulfan is mutagenic and causes chro-
areas. No health issues, comparable to those in Kasaragod, were mosomal aberrations resulting in higher incidence of various
ever reported from any of these countries (Koeman et al 1978; syndromes. Different types of syndromes present in the study
Everts et al 1983; Grant 2001). It is clear that spraying endosulfan area are examined in Table 3.
two or three times a year in a concentration of 500 ppm–750 ppm, The prevalence of the diseases and disabilities examined
is insufficient to build up enough residues in soil, water or air, are either equal to or less than the national average in the
to cause acute or chronic toxicity. endosulfan-affected areas (Table 3). We admit that the medical
camp data is not an alternative to the data generated by house-
Health Status of People in Kasaragod to-house survey in epidemiological studies. Since scientifically
With the background given above, we critically examine the designed epidemiological studies are yet to be conducted, the
available data on the health status of the people in Kasaragod for
Table 3: Incidence of Syndromes in the Endosulfan-sprayed Areas, Based on
the possible higher incidence of health issues in the endosulfan- the Compiled Medical Camp Data
sprayed areas of the district. Major Syndromes (Total Total National Remarks Reference
Population–2,97,726; Number Prevalence Average
of Live Births per Year Estimated Prevalence
Compilation and comparison of medical camp data: From 4,000 in the Last 10 Years)

the medical camps, expert doctors identified 4,273 persons with Down syndrome 62 1 in 1,000 Low Pankaj et al
(1–36-year-old patients) deliveries (2014)
300 types of diseases as victims of endosulfan poisoning (GoK
Multinodular goitre 19 8.5 in 100 Low Unnikrishnan
2011: 37). No tests were conducted in these camps to establish et al (2011)
a cause–effect relationship between endosulfan application Marfan syndrome 1 1 in one lakh Equal Reddy et al (2011)
and the disease or disability. An examination of the list would Klinefelter syndrome 1 1 in 650 Low Asirvatham et al
reveal that diseases that are very common in any village in newborn boys (2019)
Kerala alone are present in the enlisted patients. Hypertension, Turner syndrome 4 1 in 2,000 Low Maiti and
newborn girls Chatterjee (2014)
diabetes, skin diseases, back pain, toothache, piles, dementia,
Crouzon syndrome 5 1 in 3,500–5,000 Low Jacinta et al
polio, lung cancer, liver diseases, etc, were adjudged as deliveries (2018)
endosulfan-generated by the expert doctors. This is the first Source: Authors’ compilation.

50 october 9, 2021 vol lVi no 41 EPW Economic & Political Weekly

 SPECIAL ARTICLE

available data from medical camps were used here for any compared with the state average for Kerala, which is given
possible pattern in the health profile of the people of the affected in Table 5.
areas. Even if only 50% of the patients have attended the None of the disabilities examined show a statistically significant
camps, it turns out that the disabilities or diseases are not higher prevalence in Kasaragod district. The prevalence of
higher than the national or state averages. total disabilities calculated per 10,000 of the population
between the endosulfan-sprayed and unsprayed panchayats is
Disability Census Kerala, 2015: We also present data from given in Table 6.
the disability census conducted in the state in 2015, to buttress The average prevalence of disabilities is 344 in the sprayed
the argument that the frequency of adverse health outcomes panchayats, whereas it is 330 in the unsprayed ones. However,
in sprayed and unsprayed villages are comparable. Results of within the unsprayed group, there are panchayats with higher
the analysis of disability census data are presented in Table 4. prevalence than the unsprayed average, such as Bedadka and
None of the disabilities examined show a statistically signi- Karadka. Within the sprayed group, Ajanur, Badyiadka and
ficant higher prevalence in the sprayed areas. Subsequently, Kodom-Belur have a lower disability prevalence than the
prevalence of these disabilities in Kasaragod district was unsprayed group average. The prevalence of different types of
Table 4: Comparison of Disabilities in Sprayed and Unsprayed Areas disabilities between sprayed and unsprayed gram panchayats
Disability Prevalence Out of 10,000 ‘Z’ value - p/v 95% is given in Table 7.
of the Population (>1.96)
Sprayed Wards Unsprayed Wards
The prevalence of multiple disabilities is high in the sprayed
Autism 0.5 0.2 -0.573 group, whereas hearing impairment is high in the unsprayed
Blindness 7.6 7.2 -0.120 group. Other disabilities are of almost equal prevalence. It may
Cerebral palsy 1.6 0.8 -0.890 be noted that out of the 17 types of disabilities, eight each are
Chronic neurological disability 2.6 1.6 -0.714
Table 6: Prevalence of Total Disabilities in Endosulfan-sprayed and
Deaf blindness 0.6 0.3 -0.641 Unsprayed Gram Panchayats
Epilepsy 12.5 13.5 0.269 Sprayed Gram Panchayats Disabilities Unsprayed Gram Panchayats Disabilities
per 10,000 per 10,000
Hearing impaired 24.5 27.4 0.549
Ajanur 186.6 Ballal 289.0
Intellectual disability 25.0 24.5 -0.105
Badyiadka 300.2 Bedadka 380.0
Kyphosis 2.0 1.9 -0.057
Enmakaje 354.9 Beloor 342.7
Learning disability 3.0 2.5 -0.321
Kallar 381.2 Chervathur 287.2
Locomotor disability 94.1 92.5 -0.168
Kayyur–Cheemeni 353.7 Delampady 334.6
Low vision 32.9 32.1 -0.138
Kodom–Belur 304.7 Karadka 429.5
Mental illness 37.6 29.8 -1.440
Kumbadaje 452.9 Kinaoor–Karinthalam 331.0
Multiple disabilities 68.9 69.3 0.046
Muliyar 384.1 Kuttikol 331.0
Muscular dystrophy 1.3 0.9 -0.370
Panathady 355.6 Meenja 263.7
Short stature/dwarfism 2.6 2.0 -0.393
Pullur–Periye 367.0 Puthige 301.1
Speech and language disability 10.8 8.7 -0.727
Average 344.0 330.0
Total 327.9 315.1 Not significant
Source: Authors’ compilation after statistical analysis.
Source: Authors’ compilation after statistical analysis.

Table 5: Comparison of Disabilities (as per Disability Census Kerala, 2015) Table 7: Prevalence of Different Types of Disabilities on Sprayed and
in Kerala and Kasaragod Unsprayed Gram Panchayats
Disability Prevalence Out of 10,000 of Z value–p/v 95% Disabilities Prevalence per 10,000
the Population (>1.96) Sprayed Unsprayed
Kerala Kasaragod Gram Panchayats Gram Panchayats
Autism 0.92 0.44 0.50 Autism 0.4 0.5
Blindness 5.98 6.82 -0.34 Blindness 7.3 9.4
Cerebral palsy 1.86 1.23 0.46 Cerebral palsy 1.2 1.1
Chronic neurological disability 1.06 1.05 0.01 Chronic neurological disability 2.1 1.3
Deaf blindness 0.25 0.43 -0.36 Deaf blindness 0.5 0.5
Epilepsy 5.7 8.99 -1.38 Epilepsy 14.7 12.9
Hearing impaired 17.79 22.52 -1.12 Hearing impaired 29.5 35.0
Intellectual disability 20.12 24.42 -0.96 Intellectual disability 27.8 25.0
Kyphosis 1.43 1.71 -0.23 Kyphosis 2.2 2.4
Learning disability 2.36 2.05 0.20 Learning disability 3.1 2.3
Locomotor disability 76.22 80.87 -0.53 Locomotor disability 96.9 97.9
Low vision 18.07 25.79 -1.82 Low vision 37.2 40.6
Mental illness 29.48 26.71 0.51 Mental illness 34.8 33.7
Multiple disabilities 40.13 47.99 -1.24 Multiple disabilities 73.3 55.0
Muscular dystrophy 0.67 0.56 0.13 Muscular dystrophy 1.1 0.6
Short stature/dwarfism 1.77 2.1 -0.25 Short stature/dwarfism 2.1 2.5
Speech and language disability 6.61 8.14 -0.60 Speech and language disability 10.1 10.2
Total 230.42 261.82 Not significant Total 344.0 330.0
Source: Authors’ compilation after statistical analysis. Source: Authors’ compilation after statistical analysis.

Economic & Political Weekly EPW october 9, 2021 vol lVi no 41 51

SPECIAL ARTICLE

more in the unsprayed and sprayed areas, while one is equal in
both sprayed and unsprayed areas.
Health Impact of Endosulfan
A brief review of literature on toxicology of endosulfan and the
assessment of the different regulatory agencies worldwide
show that the use of the pesticide endosulfan, for pest man-
agement purposes, either by aerial spraying or ground applica-
tion, is not a matter of public health concern, though it has
been declared as a POP. This is specifically so in a tropical hot
humid environment such as Kerala, as its persistence is only
for days or weeks. The data from medical camps, and the 2015
disability census, conducted by the Department of Health,
GoK, do not indicate a higher prevalence of any of the exam-
ined disabilities in the endosulfan-sprayed region in compari-
son to the unsprayed areas.
Activists, who have attributed the adverse health outcomes
seen in some of the panchayats to endosulfan, have not sub-
stantiated their claim with any sound study. It is remarkable
that in a disaster of such magnitude as claimed, not a single
peer-reviewed paper of credibility has come out in the scien-
tific literature. National agencies that are charged with finding
the truth have taken the easy way out by endorsing the claims
of activists, without scientific scrutiny.
Conclusions
We agree that based on the precautionary principle, the deci-
sion to ban endosulfan in India is welcome. However, attribut-
ing adverse health outcomes in villages affected by aerial
spraying to endosulfan, without strong supporting evidence,
can be counterproductive. It excludes the opportunity for fur-
ther intensive study of the problem. Further, if indeed there is
some toxin that causes abnormally high incidence of certain
types of abnormalities in the area, attribution of all adverse
outcomes to endosulfan will discourage further exploration of
the problem. This is not ideal from either the point of view of
science or policy. Massive statistical comparison of the physi-
cal and mental abnormalities in sprayed and unsprayed vil-
lages of Kasaragod did not indicate any higher prevalence of
any of the health problem in the endosulfan-sprayed villages.

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Combined Government Finances module is one of the 23 modules of EPWRF ITS, which covers a wide range of macroeconomic,
financial and social sector indicators for India.
For subscription details, visit www.epwrf its.in or write to us at its@epwrf.in

EPWRF India Time Series is an e-ShodhSindhu consortium approved online database.

Economic & Political Weekly EPW october 9, 2021 vol lVi no 41 53