Health Hazards of Artisanal Mining

The Nigerian Experience

Dr. Bakri Bashir Abu Haraz

MSc PHDC, LSHTM
@Bakribashir
How the problem was discovered
• 29 March 2010: MSF surveillance team on routine meningitis
investigation to Yargamla village( LGA)
• Informed of many sick children, with a considerable number of deaths
over the previous four weeks.
• 30 March 2010, an MSF and MoH medical team visited Yargalma to
further investigate and provide clinical care
• 40 deaths in past month (39 fresh graves identified)
• All under 5 years of age.
• First death occurred in the first week of February 2010.

“Our young children are dying, they have convulsions, they go into
coma, they die”. The village chief
• Signs & symptoms
• Gastrointestinal
• Skin manifestations
• Neurological symptoms
• Change of mood
• Lethargy
• Paralysis
• Blindness and deaf
• Seizures
• MSF established a 24 hr medical care in the MoH clinic
• Supportive treatment
• Systematic treatment for malaria and meningitis
• Testing and treatment ruled out common causes of illness and death
in the area, such as meningitis and malaria
• Outbreak investigation started
• Line lists of suspected and probable cases
• Verbal autopsies and
• Household mortality surveys

• Heavy metal poisoning was suspected

• Local farming communities became increasingly engaged in mining
• Gold mining in Zamfara state is decades old, not widespread or
profitable until 2009
• Since 2009, gold price has increased substantially, from US$800/
ounce to US$1653 (May 2012)
• Renewed interest in mining in Zamfara state.
• An increasingly active artisanal mining industry digs up rocks by hand,
breaks them into pebbles with hammers, grinds the pebbles to sand
with flour mills, and extracts gold from the sand using sluicing,
panning, and mercury amalgamation (and in some cases,
cyanidation).
• Health problems associated with artisanal mining are related to
mercury and/or cyanide use
• In Zamfara, gold bearing deposits contain significant concentrations
of heavy metals in the soil and rocks
• The crushing of pebbles into sand in dry-running flour mills produces
enormous amounts of dust which in some places is highly
contaminated with lead.
• Crushing and drying happen often inside homes with cooking utensils
• Contamination of soil
• Lead can enter the body through the lungs or the digestive tract

• Gold-containing ore is precious, stored in homes at night where

people are sleeping.
hypothesis
• Heavy metal poisoning, thought to be linked to the ore processing
(gold mining) activity taking place in the village.
• The lead poisoning is a consequence of villagers practicing small-scale
mining involving extracting gold from ore that contains high levels of
lead.
• A report was made to the Nigerian Government
• Necessity for urgent action
• Invitation of experts in the field of lead exposure from US-CDC and WHO
Epidemiologic Investigation

• A line list of patients seen at MSF clinics.

• Descriptive analysis was conducted based on cases definition
• Survey questionnaire to obtain information by interviews
• Training and supervising local health professionals to administer the
survey in the fieldsdg
Laboratory Investigation

• Blood and urine samples from symptomatic children and

asymptomatic adults (miners)
• Sent to a laboratory in Germany.
• Results found blood lead levels (BLL) 109.7 to 370.9 µg/dL
 Yarlgama Dareta

Compounds surveyed (%) 100 70

U5 deaths within the last year (%) 30 20

Convulsions among dead U5 82 83

BLL <10 ug/dl in living U5 100 100

BLL < 45 ug/dl (needs chelation therapy ) 98 95

Compounds reported having at least one of the mining activities within the compounds 70 65
Environmental Investigation

• By CDC, Terra-graphics and FELTP residents

• Performed on soil/dust collected from eating or sleeping areas
• X-ray fluorescence spectrometer (XRF) used to determine content of
lead in soils, dust and bulk materials
• 98% in Yargalma and 74% in Dareta exceeded the lead threshold (400
ppm) As recommended by US EPA (range 400 to greater than 100,000 ppm).
• High levels of mercury and arsenic detected in soil where mining
occurred
• Which appeared to be related to high levels of lead.
• At 3 cM of depth inside the compounds, XRF readings dropped dramatically.
Conclusions
• 355 suspect/probable cases, and 163 deaths
• Outbreak caused by acute lead poisoning
• 100% prevalence of BLL(>10 ug/dL) among U5
• Nearly all of them warrant chelation therapy.
• Environment inside and outside compounds in both villages is highly
contaminated by lead, Limited to the top-soil
Conclusions
• Environmental contamination and timing of outbreak related to
• Increase and domestication of mining activities in both villages within the last
year
• Greater involvement of women and children processing lead contaminated
gold ore in their home environments.
• 3 other villages in neighbouring Anka LGA reported similar problems
• Assessment identified 5 villages in 2 LGAs
Unprecedented Emergency
• Not only for MSF, but for the entire global health community
• Number of people affected
• More than 2,500 children have been enrolled in the programme.
• About 2000 children are still on treatment.
• About 500 children with blood levels below 45 μg/dl are on follow-up but not
active treatment.
• Around 300 children have been discharged so far.
• 60 children have died
Unprecedented Emergency
• Number of villages involved
Unprecedented Emergency
• Incredibly high blood lead levels in the children
BLL >10µg/dL considered dangerous
>45µg/dL requires treatment
BLL >80 µg/dL causes brain damage in children
• BLL > 700 µg/dL reported in some children.
• Machines in the field cannot even test up to that level so we had to
carry out a dilution process just to be able to test the blood.
Unprecedented Emergency
• Many unanswered questions
• Why not adults
• Neutralising exposure  Moving entire villages?
• Treatment Protocols  WHO 2006 was most updated protocol available
• A vey expensive intervention
Treatment Pillars
• Environmental remediation
• Safer mining and processing practices
• Integrated medical care including chelation therapy and health
education
Project Design
Target population
• Providing clinical treatment for the most severely affected
• U5 children
• Some breast-feeding and pregnant women
• Any persons over 5 years old with serious symptoms.
Why U5s?
• Specifically vulnerable, as they are most at risk for serious morbidity and death
• Closer to the ground than adults, and often crawl, getting dust on their hands, eat
with those dusty hands, or simply put theM in their mouths.
• Absorb higher % of ingested lead, 40-50% compared to 10% in adults.
• Ongoing development of vital organs are more vulnerable to damage
Area of intervention
• Any village that is surveyed and confirmed lead toxicity
• Chelation therapy will only work with remediation (otherwise the child
continues to live in a contaminated environment and ingest lead), and in the
long term effective remediation requires safer mining practices to be
introduced.

Estimated Duration
• Initially 6 months emergency response (from April – October 2010)
Activities
• Free quality chelation treatment to the vulnerable persons with BLL >
45µg/dL
• Ensure villagers are well informed on key health messages related to
lead poisoning and treatment
• Act as a pilot project/ role model for MoH and other actors
• Advocacy and lobby to mobilise other actors
Coordinating the Response
• To prevent exposure
• No sufficient expertise to manage the crisis without assistance
• External expertise such as that of Safe Mining Experts is needed
Coordinating the Response
• External expertise proved invaluable
• WHO
• CDC
• TerraGraphics: environmental engineering company
• Blacksmith: environmental organisation
• Consultant clinical toxicologists (US, Israel and the UK)
Coordinating the Response
• SMOH
• FMOH
• Ministry of Mines and Steel Development MMSD
• Ministry of Enviroinment
• The National Water resources Institute (NWRI)
• The National Environmental Standards and Regulations Enforcement
Agency (NESREA)
• Community & religious leaders
Achievement
• Mortality rates have dropped from up to 43% to 2%
• 7 remediated villages. MSF cannot provide medical care without
remediation
• MSF clinics both IPD and OPD
Challenges
• Community acceptance
• Compliance with treatment for extended periods of time
• Ensuring clean environment for patients to return to after completion
of treatment.
• Sufficient human resources – international and national
• Continuous re-exposure to lead in villages previously remediated.
• High BLL in villages where there is ongoing unsafe ore processing.
Time is running out
Six-month Progress Report
• Reviews the steps taken to achieve the Action Plan agreed by delegates at
the
• International Conference on Led Poisoning, Abuja, May 2012
• It finds on nearly all agreed action points, very little has materialised
• The time for talk is over: it’s time to get the lead out of Bagega.
• With the release of this report, MSF is calling, in collaboration with other
stakeholders, for the urgent
• intervention of the President for the immediate release of the Bagega
remediation funds.
Time is running out
• International Conference on Lead Poisoning, Abuja, May 2012
• MSF, Nigeria CDC, and Federal MoH
• Brought together
• Leading medical, environmental and mining experts
• Government policy makers, and
• Traditional leadership
• Purpose
• Share lessons learnt and best practice
• Develop sustainable holistic solutions including immediate action plan
Lessons learnt
Innovation
• Remediation and treatment provision at extremely large scales
• Experience in clinical case management of large scale heavy metal
poisoning
(experience, contacts and knowledge of working with other actors)
• Response to an environmental contaminant, in increasingly
industrialising and urbanising developing world
Lessons learnt
• Health Policies and Power
• It’s not an acute emergency, it’s complex, widespread and chronic
public health disaster
• Medical intervention combined with environmental decontamination
and the promotion of safer mining practices was at first successful
BUT
• Hazardous mining practices continued and
• Some families see the long-term treatment as an unnecessary burden
• Making children’s treatment conditional upon adherence to safe
mining practices will not bring long-term benefit
• It puts responsibility at the wrong place, ignores power imbalances
between affected families and those who ultimately benefit from gold
trade
• Demands for better collaboration from affected communities should
take into account the ultimate causes of the outbreak
• Local power imbalances and
• Broader networks of human exploitation
• Gold and children lives are likely to be valued differently by different
actors
• Global economy led a farming community to engage into unsecure
and highly dangerous mining practices
• This conversion caused
• Death of 30–40% of young children
• Produced irreversible neurocognitive deficits among survivors, and
• Extra burden of chronic diseases among adults
• Context where gold production is the only path to escape poverty, it is
unlikely safe mining practices could be implemented or sustained
• Artisanal gold mining relies on
• Local exploitation and
• Export channels with local and international connections
Was MSF intervention useful?
• Limited programmatic choices but Nigerian authorities should address
the broader public health consequences and the regulatory issues
linked to small-scale mining.
• Public exposure of situation of an unfair system of resources
exploitation
• Way to create disincentives to unsafe artisanal mining:
• Political commitment and
• Legal solutions
 Kenule Beeson "Ken" 
• (10 October 1941 – 10 November 1995)
• Nigerian writer, television producer,
environmental activist
• Led a nonviolent campaign against
environmental degradation of the land and
waters of Ogoniland by the operations of Shell
• outspoken critic of the Nigerian government
• Tried by a special military tribunal for
allegedly masterminding the murder of Ogoni
chiefs at a pro-government meeting
• Executed in 1995 by the military dictatorship
of General Sani Abacha