Dr Manzurul Hassan is geographer and faculty member of Jahangirnagar University in Bangladesh.  He did his MSc and PhD in the Department of Geography at Durham University. After completing his PhD in 2003, Dr Hassan did a number of research works on groundwater arsenic poisoning.  Apart from this, he has conducted some consultancies in the development field with different national and international organisations and donor agencies.  He is now actively involved in writing-up his book Arsenic in Groundwater: Poisoning and Risk Assessment with Professor Peter Atkins (IHRR/Geography) to be published by the CRC Press (USA).  An important update on part of this research is now available.

How did groundwater arsenic contamination become a health hazard in Bangladesh?

Skin lesions from arsenic poisoning (Manzurul Hassan)

 

There were waterborne diseases such as diarrhoea in Bangladesh due to the drinking of untreated water several decades ago.  During the 1970s, UNICEF and some international donor agencies advised the Government of Bangladesh to tap groundwater for drinking purposes.  Drinking this groundwater actually reduces the level of diarrhoea, but at the same time it is increasing the risk of arsenic poisoning, leading to arsenicosis, hyperpigmentation, gangrene, and finally cancer.  The latency time of cancer symptoms is 15-30 years depending on arsenic content in the water and the period of ingestion.  Local poor people are not actually aware of arsenic poisoning.  They still think that tube well water is good quality and that it is much better than the surface water, whether it is contaminated with arsenic or not.

What are the social hazards associated with arsenic poisoning?

Some social problems have emerged other than health risk from arsenic poisoning.  There is a very common tendency to ostracise people who have visible arsenic symptoms on their body, particularly different types of skin lesions or gangrene.  People with arsenic poisoning can’t even go outside of their own home and they can’t participate in any social gathering.  There are even problems within families causing parents to separate or the infected to leave home.  They are isolated from society; they find it difficult to get a job and children cannot go to school.  These are the kinds of social problems in Bangladesh within arsenic-affected communities.

 

Arsenic-safe deep tube well in Satkhira, Bangladesh (Manzurul Hassan)

What policies have been developed in Bangladesh in response to health risks and hazards caused by arsenic contaminated drinking water?

If you think about risk to arsenic poisoning, two issues should be considered: (a) health risk with disease incidence; and (b) social implications.  Arsenic is a documented carcinogen and if people ingest arsenic contaminated drinking water for a long time, there is the possibility of non-malignant symptoms as well as different cancers.  There is a large literature regarding arsenic and health issues but the social implications of arsenic poisoning have yet to be focused on strongly.  There are serious social problems for the arsenic-affected people in Bangladesh, starting with children being excluded from school, followed by social isolation and family dislocation.  In 1997, the government established an umbrella organisation — BAMWSP (Bangladesh Arsenic Mitigation and Water Supply Project) for arsenic mitigation in Bangladesh.  BAMWSP developed a policy in 2004 for arsenic-safe water options and these were: rain water harvesting, deep tube wells, pond-sand-filters and dug wells.  In 2005 there was an assessment of the options and the installation of deep tube wells was banned by the government until it could be determined whether the arsenic-safe deep aquifer was protected by an impermeable layer.  If the deep aquifer is ever contaminated with severe levels of arsenic, there will be no option for arsenic-safe drinking water.  Furthermore, the other options are not working properly in Bangladesh.  Therefore, government needs to formulate a constructive policy to save her people from arsenic poisoning.  It is worth noting that about 80 million people in Bangladesh are at risk of arsenic poisoning.

How can people protect themselves from arsenic poisoning in Bangladesh?

Since the educated portion of the population in Bangladesh is not large, it is sometimes difficult to convey awareness messages regarding arsenic poisoning. Some understand arsenic hazard, but others confuse arsenic with iron.  This is because the messages are sometimes complicated and lack clarity.  Generally, people think that arsenic poisoning is a contagious disease that spreads quickly.  This is a common misconception in rural Bangladesh.  If a mass awareness campaign is possible to alert the rural people, and if they can be provided with arsenic-safe water, the arsenic problem will be minimised in Bangladesh.  Arsenic-safe water is the only curative medicine for arsenic-related diseases at the primary stage.

What do you think is the most appropriate safe drinking water arsenic threshold for Bangladesh?

If you consider the Bangladesh standard permissible limit for drinking water that is 50µg/L of arsenic, around 30% of the tube wells are found to be contaminated; but this figure is more than doubled if the WHO guideline value (10µg/L) is used.  There is a lot of literature regarding the permissible limit of ingesting arsenic from drinking water. The guideline value of 50µg/L does not provide full protection from arsenic poisoning, but the implementation of the WHO standard would be very expensive.  The existing mitigation options for arsenic-safe drinking water are not working properly and there is no regular monitoring of drinking water quality.  There is still ongoing research on safe water options in Bangladesh, and there is debate about which technology is suitable and sustainable.  The low-cost technologies are suitable for the rural poor but might not be sustainable.  High-tech options are most applicable for towns and cities but they are expensive and not all consumers are able or willing to pay the cost of arsenic-safe water.

How were qualitative methodologies useful for your research in Bangladesh on social hazards and risks from arsenic poisoning?

Both quantitative and qualitative enquiry are useful for social hazard and risk research on arsenic poisoning in Bangladesh, but qualitative methodologies seem to me to be the most reliable and effective in this regard.  In understanding the meaning of pain in the lives of arsenic-affected patients and their social problems, qualitative enquiry with the “interpretive hermeneutical phenomenology” of Max van Manen, and the “grounded theory approach” of Anselm L Strauss and Barney G Glaser are suitable.  One can also use quantitative methods for assessing the health risk of arsenic poisoning, but they are not always suitable since it is not possible to quantify the “pain” of the arsenic-affected people.  Moreover, in making the relationships between social norms of the arsenic-affected people and their social problems with arsenic poisoning, the qualitative methodologies are most helpful.  Participant observation with ethnography could be used to detect the arsenic impact on social life of the affected people.  Arsenic-affected people are generally found not to disclose their disease to anybody in rural Bangladesh and they manage their social and family lives in their own way.

What role can IHRR play in addressing massive hazards like arsenic ground water contamination in Bangladesh?

There is arsenic poisoning now in 70 countries around the world and about 80 million people are at risk of arsenic poisoning in Bangladesh alone.  At the beginning of arsenic detection in Bangladesh groundwater in 1993, a good number of international institutions, donors, research institutions and international NGOs contributed their efforts both in research and mitigation.  The British Geological Survey (BGS) with the financial supports from the DfID/NERC conducted research on groundwater arsenic poisoning.  Some foreign institutions, like Columbia University (USA), KTH (Sweden), Jadavpur University (India) are still working on arsenic in Bangladesh.  The Institute of Hazard, Risk and Resilience (IHRR) can play a role in research on this issue.  The objectives of the IHRR can be achieved with long-term research on different natural disasters that are frequent in Bangladesh.  The recent Link Programme with Jahangirnagar University under the British Council INSPIRE programme can be the beginning of the research initiative.  I hope IHRR can have the scope to formulate new guidelines and policies for arsenic mitigation that could be helpful to save millions of people in Bangladesh as well as other arsenic-affected countries.

Manzurul’s website (under construction): http://manzurul.info/index.html

Further Reading:

Atkins P, Hassan M and Dunn C. Environmental irony: summoning death in Bangladesh. ENVIRONMENT AND PLANNING A.    Volume: 39    Issue: 11    Pages: 2699-2714

Exploring groundwater arsenic contamination in Bangladesh. IHRR Blog

Hassan MM and Atkins PJ. Arsenic risk mapping in Bangladesh: a simulation technique of cokriging estimation from regional count data. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH PART A-TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING. Volume: 42    Issue: 12    Pages: 1719-1728

Atkins P, Hassan M and Dunn C. Poisons, pragmatic governance and deliberative democracy: The arsenic crisis in Bangladesh. GEOFORUM    Volume: 38    Issue: 1    Pages: 155-170

Atkins P, Hassan M and Dunn C. Toxic torts: arsenic poisoning in Bangladesh and the legal geographies of responsibility. TRANSACTIONS OF THE INSTITUTE OF BRITISH GEOGRAPHERS. Volume: 31    Issue: 3    Pages: 272-285

Contamination of drinking-water by arsenic in Bangladesh: a public health emergency. Bulletin of the World Health Organisation. Volume: 78 Issue: 9

Irrigation threatens drinking water in Asia. Futurity.org

Hellish Water. Sciencebase