68 THE ARSENIC CRISIS IN BANGLADESH’ Christine Marie George Asststawr Paorrsson, joss Horxixs Broostarne Scitoot oF Pvstre Hain, Dupasrawn7 oF Ivruawationat teatiit, Gosat Disease Eriweaio1ocy AND CowTRo1 PROGRAM, BALIIMORE, MD, USA, Learning objectives 1. Understand the history of the arsenic problem in Bangladesh, from drinking water 2. Ldenify health implications of chronic arsenic expostr. 3. Understand the complexities of developing sustainable arseni mitigation strategies. History of the arsenic problem Dring the 1970s, the government of Bangladesh in collaboration with the United Nations Children’s Fund (UNICER) encouraged 2 shift from using microbislly contaminated tapped groundwater (Kinniburgh, 2001). Wells were believed lative to surface water that was easy to install, surface water to wells to represent a safe drinking water option 5 relatively cheap, and required low maintenance. However, by the early 1990s it was apparent that many of these wells tapped shallow aquifers with elevated levels of naturally occurring arsenic (Dhar etal, 1997). The shift to wells was est 35 million to water arsenie concentrations that exceeded the Bangladesh arsenic standard of 50 ug/L. (Figure 68.1), and an even higher number ifthe World Health Organization (WHO) arsente guideline of 10 ug/L is used (Ahmed et al, 2006). levated levels of arsenic in the shallow groundwater aquifer have been found across Asia (Reador! ct al, 2010). An estimated 100 million people in India, Bangladesh, Vietnam, Nepal, and Cambodia are exposed to water arsenic concentrations exceeding the WHO arsenic guideline (Ahmed ct al, 2006). The elevated naturally occurring arsenic in the region, is hypothesized to be the result of arsenic-rich iron oxides in sediments being dissolved and released into the groundwater aquifer (Zheng et al, 2004; Fendozt et al, 2010), ated to expose a population of 28 to © Recommended citation: George, C.M. 2015. ‘The arsenic esis in Bangladesh, in Bartram, J, with Baum, R, Corlanis, PA, Gute, DM, Kay, D., McFadyen, S., Pond, K., Roberson, Wand Rouse, (MJ. (eds) Routledge Handoot of Water and Heath, London and New York: Rostledge 667The arsenic crisis in Bangladesh Health implications of arsenic exposure Exposure to elevated levels of inorganic arsenic is associated with an increased risk for cancers ofthe lung, bladder, and skin (Chen and Ahsan, 2004), cardiovascular disease (Chen et al, 2011), neurological effects (Wright et al, 2006), skin lesions (Haque et al., 2003), respiratory effects (Parver et al, 2008), and all-cause mortality (Argos ¢tal., 2010), Chronic senic exposure is also associated with deficits in childhood cognitive and motor function (Wasserman etal, 2007). Arsenicosis is defined as chronic clinical toxicity due to high levels of arsenic being present in the body. Clinical symptoms of arsenicosis can include: melanosis, spotted and diffise kkeratosis om the palms and soles, and dorsal keratosis (Saha, 2003), These arsenic-induced skin the most common visible clinical sign of toxicity from chronic arsenic ‘exposure (Vs et al, 2006), though overall morbidity and mortality are more strongly derived from internal organ damage which often occurs in individuals without skin lesions, Arsenic induced skin lesions were observed in West Bengal, Inia, as early as the 1980s (Chakraborty and Saha, 1987), In contrast to other diseases associated with arsenic, atsenicosis has been reported after a short duration of expostre (Ralsman et al, 2001). In the years to come Bangladesh will face a rapid increase in arsenic-related diseases due to the latency period of many of the associated illnesses, Many of the new generations born after the switch to wells will likely face a lifetime of chromic arsenic exposure. It has been ‘estimated thatthe arsenic crisis in Bangladesh will resultin more than a doubling of the fture ‘excess cancer risk for this exposed population (229.6 versus 103,5 per 100,000 poptlation) (Chen and Ahsan, 2004), Alarmingly, a recent study estimated as many as 42,000 deaths in Bangladesh annually are associated with chronic arsenic exposure above 10 ug/l. Over the next 20 years this arsenic-related mortality could lead to estimated economic losses of 13 billion USD if the current arsenic exposure in the poptilation remains the same (Flanagan tal, 2012) lesions Policy and arsenic mitigation In the early 1990s, after the scale ofthe arsenic problem was recognized, there was a national survey of water arsenic concentrations in groundwater sources conducted by the Bangladesh Department of Public Health Engineering (DPHE) and the British Geological Survey (Kinniburgh, 2001). Groundwater arsenic concentrations in Bangladesh were found t0 be the lowest in the northern part of the cotuntry and the highest in the southern part. In 1999, DPHE with support from the World Bank and UNICEF undertook a nationwide water arsenic testing campaign under the Bangladesh Arsenic Mitigation and Water Supply Program (BAMWSP) (DPHE, 2010a). Through this program they were able to test close t0 5 million wells using field arsenic test kits throughout the country from 1999 to 2005 (DPHE). During the national testing campaign, wells were painted red if they exceeded the ‘Bangladesh arsenic standard, and green if they were below this standard, Approximately 30 percent of these 5 million wells were found to have arsenic concentrations that exceeded the Bangladesh arsenic standard of 50 ug/L. Johnston and Sarker, 2007), This campaign was ‘one-off in scope and did not disseminate messages om the health implications of arsenic, ot provide arsenic testing over time as new wells were installed, in 2004, the Bangladeshi government issited a National Policy for Arsenic Mitigation ‘This policy promoted the use of the following options for arsenic mitigation: improved dug wells, pond sand filters, large scale surface water treatment, deep wells, rainwater 669Christine Marie George harvesting, arsenic removal technologies (ART), and piped water supply systems (National Arsenic Mitigation Information Center, 2004) The Bangladeshi government lso set up the Bangladesh Environmental Technology Verifcation-Support to Atsenie Mitigation (BETV- SAM) program under the Bangladesh Council of Scientific and lndustrial Research, BETV- SAM was responsible for evaluating the effectiveness of potential ARTS to be used in the county, Evaluations were based on the ability of the ART to consistently provide water ‘below 50 jg/L arsenic, o produce manulieturer specified quantities of arene sale water and toadhere to national water quality standards. Ta date, ive household level ARTS and one ‘omnmitnity evel ART have been approved wader this program. OF the population of 28-35 mallion initially exposed to atsenie above the Bangladesh standard, 57 percent ae estimated to remain exposed. The most common arsenic mitigation option used by the affected population is well switching at 2 percent (Abmed et a 2006). This volves arsente unsafe well users switching to asente safe wells relative to the Bangladesh arsenic standazd (<50,ug/L As) located in their comauuities. This is posible dc to the spatial heterogeneity in the distribution of arsenic in the shallow groundwater aquifer (Van Geen et , 2002). Intervention studies in Bangladesh which encouraged well switching Uhzough health promotion and water arsenic testing have observed significant reductions 3 turimary arsenic concentrations « lomarker of arsenic expostite individuals who reported switching to arsenic safe drinking water sources (Chen etal, 2007; George et sb, 20128). ‘Well switching has been found to be most effective in communities with Low to arsenic contamination (0-60 percent of arsenic unsale) relative to the Bangladesh arsenic standard (George ot al, 20123), This is estimsted to inclide 77 percent of the population in Bangladesh. Well swatching, however, is not an option in highly atsenic-contaminated areas of the countay where moze than 80 percent of shallow wells exceed the local arsenic standard. One potential concern for well switching is the temporal variability of the arsenic woncentzations in + well over time. Previous studies, however, have found the temporal variability of arsenic concentzations im wells overtime to be low (Dhar etal. 2008; Cheng etal, 2005; Steinmaus eta, 2005; Thusiyl eta, 2007; Feadorf etal, 2010). Rate events, such s the entry of srsenic contaminated groundwater through cracks i pipes, however, ea, lead to the contamination of wells originslly labeled 4 asente safe relative tothe Bangladesh arsenic standard (vant Geen eta, 2007) “The second most common arsene mitigation option is the use of deep wells, now used by sn estimated 12 percent of the affected population (Abmed etal, 2006) Studies have shown that deep groundwater aquifers (> 150 m) generally have arsenic concentration below 10 ug/L (Radloff etal, 2011). Therefore the snstllation of deep wells s another viable option, for areas that have arsenic in shallow groundwater. One barrier tothe widespread use of deep ‘wells is their high cost, which can be up to 1500 USD depending on the depth of the well. ‘Arsenic mitigation options such as rainwater collectors, dugwell, arsenic filters, and pond sand filter ate estimated to be used by les than 2 percent ofthe arsenic affected poplation im Bangladesh (Aled ct al, 2006). Barriers to the widespresd use of arsenic removal devices Ihave been mostly related to inadequate mintenance, frequent clogging of filters, and lack of ser ftendliness ofthe technologies used (Hoss tal, 2005). In addition, the us of dugwells and pond sand filters have been associated wath mnicrobil contamination (Howaed etl, 2006). national drinking water quality survey conducted in 2009 fownd that 20 million and 43, rillion people were sill exposed to arsenic that exceeded the Bangladesh srsenic standard of 50 ug/l sd the WHO arsenic guideline of 10 yl respectively Pathey, 2009). A major barriee to arsenic mitigation in Bangladesh isthe lack of access to water arsenic testing services I many regions of Banglades it has been neatly 10 years since the previous nationwide woderate 670The arsenic crisis in Bangladesh arsenic testing program. However, the number of new wells being installed continues to grow rapidly (George et al, 20126). ‘The arsenic status of 44 percent of wells in arsenic affected sub-districts of Banglidesh is unknown (DPHE, 2010b), Furthermore, the paint used to label wells red or green relative to the Bangladesh arsenic standard in the previous nationwide arsenic testing campaign has long ago faded, Without information on the arsenic status of household drinking water, the population will continue to be exposed to elevated trations in drinking water ‘There has been an emergence of rapid field tests for measuring arsenic in drinking water. These field kits ae relatively low in cost (0.17-0,60 USD/test) and have a reaction ume of 10 to 40 minutes (George et al, 2012c). Previous studies have demonstrated that village workers with relatively litte training are capable of eflectively sing these water arsenic testing kits (George et al, 20126). The Ministry of Local Government and Rural Development Cooperatives of Bangladesh, in collaboration with UNICEF and several other developmental agencies, recently piloted a fee-based well water testing program for arsenic. ‘This program trained arsenic testers in eight sub-disticts of Bangladesh to go doot to door to offer fee-based water arsenic testing services. The revenue from the arsenic testing went to purchasing additional arsente testing kits. An evaluatioa in Shibalaya sub-district found that the vast majority of houselolds (93 percent) purchased an arsenic test for their well when {fee-based arsenic testing was combined with an arsenic educational program (George et a. 2013). An advantage of fee-based arsenic testing is that it provides a financial incentive for the tester to seek out untested wells (George et al, 2013; van Geen, 2013) ‘Bangladesh currently lacks atsente safe drinking water options to serve the entire arsenic affected populations, Without arsenic testing, the number of untested wells will rise as new swells are installed and snillions will unknowingly be exposed to elevated arsenic in drinking ‘water. As we approach the 40 year mark since the arsenic crisis first srose for this country, sustainable arsenic mitigation strategies are urgently needed. ‘The most sustainable arsenic ‘mutation strategies will likely be those that build local capacity through fee-based arsenic testing implemented by villager workers. Another massive blanket water arsente testi sign that is free of charge would likely also reduce arsenic exposure, but would probably delay the viability of commercial arsenic testing for several years. Furthermore, this type of top-down approach leaves no infrastructure for future testing programs. In highly arsenic ‘contaminated areas of the county, targeted installation of deep wels will likely be the most sustainable approach over the long term. In addition, government policies are needed that ‘mandate the installation of deep wells in ateas that are easly accessible by the majority of the affected populations. Focusing efforts on arsenic removsl technologies will requize 4 higher Jong term infrastructure cost in comparison to deep wells because of the maintenance, personnel, and replacement cost associated with these systems, In 2009, DPHE worked in close collaboration with the Japan International Cooperation Agency to conduct s sitational analysis of arsenic mitigation for the country. Through this program a database was established to collect information on the location of arsenic safe ‘water options ins each arsente affected sub-district. This has allowed the country to identity and target high priority areas where the percent of arsente safe water options is low and the proportion of the arsenic contaminated drinking water sources is high. The situational analysis found that 154,236 deep wells and 10,250 deep ‘Tira pumps were functional in arsenic affected areas of the country, providing arsenic safe water fo an estimated 23 percent of the affected population, This report did not evaluate the smpact of well switching; however, ‘as estimated that approximately 70 percent of the arsenic safe water sources sed by the affected population were shallow wells (DPHE, 20108). enChristine Marie George Key recommended readings 1 Chen, ¥. & Ahsan, H. 2004. Cancer burden from arsenic in drinking water in Bangladesh, An J Public Health, 94(3)'741-4, These results indicate that the arsenic crisis in Bangladesh will result in more than a doubling of the future excess cancer tisk for this exposed population (229.6 versus 103.5 per 100,000 population). 2 Abmed, M.F, Ahuja, S., Alauddin, M., Hug, S. J, Lloyd, J. R, Pfafi, A, Pichler, T, Saltikow, C., State, M. & Vin Geen, A. 2006, Epidemiology. Ensuring safe drinking water in Bangladesh. Science, 314(5806):1687-8. This article gives an overview of arsenic mitigation options available to arsenic exposed populations in rural Bangladesh, 3. Flanagan, S. V, Johnston, RB, & Zheng, Y. 2012, Arsenic in tube well water in Bangladesh: health and economic smpacts and implications for arsenic 1 Bulletin ofthe World Health Orgenization, 90(11):839~46, ‘This article estimates arsenic related mortality rates and economic losses associated with the arsenic crisis in ‘Bangladesh, References Ahmed, M., Abuja, S. Alauddin, M, Hug, S.J. 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